Tackling health inequality could help avoid 5,400 premature deaths

UP TO 5,400 premature deaths could be avoided each year if policy-makers took a more robust approach to tackling social deprivation and health inequality, according to a report to be published today.

Research by the Institute of Public Health and the Combat Poverty Agency says poor housing, nutrition and education are to blame for high levels of ill-health and early deaths among poor and socially excluded groups.

Official figures show that those further down the social ladder run at least twice the risk of serious illness and premature death as those near the top.

For example, almost 40 per cent of people at risk of poverty in the Republic report suffering from a chronic illness, compared with 23 per cent of the general population.

The pattern is repeated in Northern Ireland, where some 47 per cent of unskilled workers suffer from long-standing illnesses compared to 30 per cent of professionals and managers.

The report, Tackling Health Inequalities - An All-Ireland Approach to Social Determinantsaims to help policy-makers understand how their decisions can influence health in areas such as housing, education, transport or social care.

It says major strides can be made in tackling poor health and premature deaths by ensuring Government departments and public agencies work more closely with communities to provide equitable, accessible health and social public services.

These commitments must be accompanied by setting targets and monitoring of progress in attempts to narrow the health gap between rich and poor.

The report quotes research by the Department of Health in Northern Ireland which estimates that at least 5,000 fewer people would die prematurely each year across the island of Ireland through the tackling of social deprivation and inequalities.

The chief executive of the Institute of Public Health, Jane Wilde, said its latest report graphically illustrated the impact of health gaps in terms of lives lost and harmed.

"As well as the injustice of inequality, there is a real and fundamental cost to the economy. This undermines the island's competitiveness in a global market as well as placing unnecessary pressures on our two health services. Government action is urgently needed," she said.

"The underlying causes of these health inequalities are examined, and how decisions made in many sectors have the capacity to influence health and well-being is emphasised, especially for disadvantaged people."

The acting director of Combat Poverty, Kevin O'Kelly, said many of the social factors that cause and perpetuate health inequalities among low-income groups are outside of the control of the health services.

He said the report demonstrates the extent to which reducing health inequalities and improving the health of the population depends on preventative measures across a range of policies.

"It is not simply the responsibility of the health sector but requires a whole-of-Government approach to health," he said.

The research suggests that the Republic and the North have some distance to go in reducing inequalities in society.

Latest official figures indicate that around 7 per cent, or 300,000 people, in the Republic are living on low incomes and deprived of basic necessities. The highest risk groups are the ill, disabled and members of lone-parent households.

Figures for poverty and social exclusion suggest that the gap between rich and poor is wider in the North compared with the Republic.

The publication coincides with the launch of the final report of the World Health Organisation's Commission on Social Determinants of Health.

This group brings together leading experts to provide evidence on policies that improve health by addressing the social conditions in which people live and work, as well as collaborating with countries to support policy changes and help to monitor results.

Health inequality: case study

EILEEN* LIVES a short distance from Dublin's city centre, but it sometimes feels a million miles away from a health service that could transform her family's life.

She lives with her disabled 27-year-old daughter in a local authority house in the Fettercairn area of Tallaght. They don't have a car, so getting her daughter in her wheelchair to the doctor's surgery is an ordeal.

Eileen isn't entitled to a carer's allowance or respite grant, because she works part-time as a kitchen hand while her daughter is in the workshop.

They could do with a personal assistant or some respite, but they can't afford one privately.

"You feel like you have to fight for everything," she says.

"My daughter's life could be so much different if there was more support available. As it is, she's confined to the house most of the time and doesn't go out much. She loves going to the pictures or going out with friends, but a lot of the time it's just not possible."

One of the most unfair aspects of living on the wrong side of the health inequality divide, she says, is how the welfare system traps families in their circumstances.

"Because I'm working, the only thing she's entitled to is a clothing grant; there is no carer's or respite allowance."

They have had some improvements in recent years: a housing grant helped to pay for modifications to the house for her daughter. Also, she's been told her daughter qualifies for a personal assistant, although they have no guarantee she'll get one.

"We're not the only ones in this situation," Eileen says.

"But when you don't have the money to get services privately, you have no choice but to rely on the public service."

* Eileen's name has been changed, at her request.

Health inequalities: the figures

42The average age of homeless people who died prematurely on the streets in 2006

5,400The estimated number of premature deaths each year as a result of health inequalities

47%The proportion of poorer people who have a chronic illness, compared to 23 per cent in the general population

300,000The number of people in the Republic who are living in consistent poverty and deprived of basic necessities

200%The difference in age-related death rates between the lowest social and highest classes

Source:Tackling Health Inequalities - An All-Ireland Approach to Social Determinants, by the Institute of Public Health and the Combat Poverty Agency